What are my rights in getting revisions to flap donor site?

Anonymous
Anonymous Member Posts: 1,376
edited July 2017 in Employment, Insurance, and Other Financial Issues
What are my rights in getting revisions to flap donor site?
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  • Ad197
    Ad197 Member Posts: 38
    edited July 2017

    I had bilateral Sgap. All went as planned with no complications according to my doctor. I am not happy with what my doctor did to me. I am worried that insurance will not pay to have my donor site revised anymore after I had stage 2 and I still have work that needs to be done. My insurance coordiator advised me to not go back to him and also told me that no other doctor would fix me. I can't live with the way I look. I don't know who to go to for more revisions. Do I have to live with my buttocks deformed? I am young and this has been a nightmare. Any advice greatly appreciated.


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  • Meow13
    Meow13 Member Posts: 4,859
    edited July 2017

    What area are you in? My plastic surgeon did a fabulous job I'm in Seattle.

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  • Ad197
    Ad197 Member Posts: 38
    edited July 2017

    I traveled out of state for my reconstruction. I am willing to travel

    I forgot to add above that my insurance coordinator told me that no other doctor would fix me.

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  • Lula73
    Lula73 Member Posts: 1,824
    edited July 2017

    Ad-so sorry you're dealing with this. Don't know where you went but I know the docs at NOLA (the center for restorative breast surgery in New Orleans) routinely correct botched breast reconstruction including the other areas of the body that were affected due to the nature of the surgery. And they get insurance to cover it even if it's after initial stage 2 Its worth a call. Here's their website: www.breastcenter.com

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  • Ad197
    Ad197 Member Posts: 38
    edited July 2017

    Lula -Do you know of anyone that went to NOLA to fix their buttocks? Could you please give me their contact info? What Doctor is best at fixing the buttocks?

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  • Lula73
    Lula73 Member Posts: 1,824
    edited July 2017

    Ad- their are several women who've had revisions to their buttocks at NOLA post SGAP but they're on the NOLA private Facebook page. You'll need to look up Betsy Schreier Davis on Facebook and ask if she can add you to the group as you're looking into going to NOLA for stage 2b SGAP.

    The website has some great before and after pics for examples of what you can expect with SGAP results front and back. They also have a lot of helpful information about what makes them different from the other centers (like focusing on restoring all areas that are affected by the surgery til you're happy and working to correct botched recon surgeries performed elsewhere). A phone consult with their patient educator is free as is the insurance coverage check. After talking with the patient educator you can send photos as well to be evaluated for what they can offer you based on your individual case.

    Wishing you luck

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  • Ad197
    Ad197 Member Posts: 38
    edited July 2017

    I am not on facebook. Is there another way to contact these women who have had buttock repairs

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  • Lula73
    Lula73 Member Posts: 1,824
    edited July 2017

    that's the only one I know. Betsy is on this site too-you can try searching her name and sending her a pm. I know she had SGAP and buttock repair at NOLA

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  • debiann
    debiann Member Posts: 1,200
    edited July 2017

    I had a DIEP flap and two revisions. I was not completely happy with the results and asked for one more revision. My PS said no, that's as good as it will get. That PS moved so when it came time for nipples I had to see a new PS. He agreed that there was some fixing to do and he did a third revision that was paid for by insurance. The final results were great. Hope things work out for you.

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  • Ad197
    Ad197 Member Posts: 38
    edited July 2017

    deb - I am happy you got your revision. I hope I can find someone to fix me too

    Lula - Thanks, but I can't go to NOLA. I need other options. I am looking for other surgeons that repair buttocks and take my insurance. I will contact Betsy aka bdavis and ask for suggestions.

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  • Lula73
    Lula73 Member Posts: 1,824
    edited July 2017

    ad- sounds like NOLA is out of network for your insurance. It was for mine too. 2 questions- what are your out of network benefit levels? How close is the nearest surgeon who does DIEP flap to where you live? If the nearest DIEP flap surgeon is 50mi or more away from your home then you will likely qualify for out of area benefits that allow you to go out of network and qualify for higher reimbursement (usually 100% of reasonable & customary for your area vs the standard out of network benefit). Worth checking into it as it may make NOLA a viable option.

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  • Ad197
    Ad197 Member Posts: 38
    edited July 2017

    There is no DIEP surgeon within 50 miles. I checked with insurance and I will have to pay out of network fees. We can't do that. Even in network is too high. We planned on having this done in one year. We don't know what we are going to do. I pm' bdavis just now.

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  • Lula73
    Lula73 Member Posts: 1,824
    edited July 2017

    have you looked into dr Craigie or Dr Massey in Charleston, sc?

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  • Ad197
    Ad197 Member Posts: 38
    edited July 2017

    I was just looking at PRMA. I wonder if they could help. It looks like they do one side at a time, but they could help me with my revisions. I don't know which PRMA doctor does the most sgaps?

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  • DiepGal
    DiepGal Member Posts: 12
    edited July 2017

    Hello Ad197. I would suggest reaching out to the patient liaison at PRMA, Brittany. She may be able to answer your question directly. May be worth it to shoot her an email. From a personal standpoint, I had a DIEP at PRMA and needed a lot of revision in my circumstance because of radiation I had 12 years previous to my DIEP. I was also a delayed DIEP. I am truly happy with my results. It was not an SGAP but I know they are excellent with revision issues of all kinds in breast reconstruction there. Hope this helps and I'm happy to answer further questions.

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  • Ad197
    Ad197 Member Posts: 38
    edited July 2017

    I called PRMA and they said any revisions to my buttocks can only be done by original doctor for insurance to pay. My buttock deformity is directly caused by the SGAP. I have seen women get their diep donor site revised by other doctors than the original one who did the diep. Did insurance pay for that or was it considered cosmetic Can I fight this? How?


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